Ineffective communication of mental status information during care transfer of older adults

Monitoring and documenting the mental status of older patients transferred between providers or facilities is important because mental status change can be a sign of acute disease and mental status abnormalities necessitate specific approaches to care.

To identify patient and illness factors associated with presence of a mental status description in inter-facility transfer documents and to describe the content and concurrent validity of transfer mental status descriptions when they occur.

Retrospective study.

Individuals transferred between 5 long-term and 2 acute care facilities in an urban setting.

Trained research personnel reviewed hospital and nursing home medical records and inter-facility transfer documents. Mental status descriptions in transfer documents were coded as abnormal or normal within 5 domains: alertness, communication, orientation/memory, behavior, and mood. Descriptions were compared with mental status items in the nursing home Minimum Data Set and in a transfer communication checklist.

In all, 123 nursing home residents experienced 174 hospital admissions. Mental status descriptions were present in 69% of transfer documents. A total of 67% of patients missing a transfer mental status description upon nursing home-to-hospital transfer had dementia. Factors associated with presence of a transfer mental status description were urgent transfer, nursing home of origin, and among patients without dementia, greater cognitive impairment. When present, a mean of 1.47 (SD=0.81) cognitive domains were documented in transfer mental status descriptions. Agreement between transfer mental status descriptions and comparison sources was fair to good (kappa=.31 to .73).

Mental status documentation during transfer of older adults between nursing home and hospital did not identify all patients with dementia and did not completely characterize patients' cognitive status.